My MOC Debacle: Nevermind That $2,100 Exam You Just Passed

M.D. Financial ServicesA couple years ago, I reached the seven-year mark after my initial Board Certification with the American Board of Anesthesiology (ABA). At the time, it was a significant milestone. I was eligible to take the all-important Maintenance of Certification in Anesthesia (MOCA) exam.

Diplomates of the ABA — that’ right, I’m considered a diplomate — in other words, a board-certified anesthesiologist. Diplomates were encouraged and incentivized to take the $2,100 exam early in the three-year eligibility window.

The exam was only offered twice a year. There were testing dates during a few weeks in the summer or a few weeks in the winter. You could take the exam up to three times to pass and maintain Board Certification.

In other words, if you fail, you could take it six months later, and if you fail again, you get one more shot. Waiting until the last opportunity would take away your ability to retake the exam before initial Board Certification could expire.

Like A Dutiful Diplomate, I Signed Up.

 

I really didn’t feel much like studying in the spring and summer for the exam, so I passed on my first opportunity, signing up for winter window.

I didn’t feel much like studying for this test at all, but I knew that I had better put the time in. Just like I’d rather work a bit longer and retire with more money than I need, I’d rather go into an exam with more knowledge than required.

I also felt a need to study because the vast majority of the material on the exam had little relevance to my actual job. The exam covered all topics that an anesthesiologist might encounter, such as chronic pain (which I don’t manage), open heart surgery (which I haven’t seen in years), and brain surgery (don’t see that, either).

There were esoteric facts to memorize, and memorize I did. You know the age-old question of the trains traveling towards each other at different rates of speed? We have questions like that, only they come in the form of a gas in an E cylinder that is partially full and flowing at X liters per minute. To answer correctly, you need to commit to memory the volumes of full tanks of various gases, and whether or not they are stored in liquid or gaseous form.

In practice, I start with a tank at least half full and don’t travel very far. But I relearned all the numbers (had to know them for the initial written exam eight years earlier) and I memorized a whole bunch of other minutiae that might be only peripherally related to anesthesia. Facts that are taught to be tested, and serve little practical purpose.

For a couple months, I studied when I could. I took advantage of down time at work in the afternoons and evenings, and took myself to the library on some days off.

Uncoincidentally, the aggravation of studying for a really expensive and largely irrelevant exam led me to explore the possibility of retiring before having to take the dumb test again, a story I told in the aptly titled Inception.

I would be taking the exam in the second of six opportunities. As much as I wasn’t planning to fail, failure was a viable but expensive option since I’d have four more testing windows in which to retake the test.

Taking the test early seemed prudent.

About a month after the exam, I received wonderful news via mail. I passed!

 

ABA Passing Score

 

I overstudied, but as a “bread and butter” anesthesiologist who hasn’t seen a teaching institution in years (except for the time I spent $1,500 for a day in the simulation center to meet additional MOCA requirements), I thought it was best to study up rather than take my chances.

This was the last of my MOCA requirements for the initial ten-year period. According to the letter accompanying the score report, “Upon successful completion of all MOCA requirements, you will be issued a certificate that well be valid for 10 years from the date of issuance.”

Two months after receiving that letter, I received more news. A MOCA redesign that the ABA had beta tested the prior year was to be implemented for all. The exam that I just passed was replaced with MOCA 2.0. Thousands of fellow diplomates who certified the year I did or the year before who had not yet spent the $2,100 were now excused from having to take the exam.

 

Wait… wait. What?!?

 

That’s right. Doing the responsible thing, the thing that the ABA encouraged, turned out to be a huge waste of time and money.

I’m not so naive to believe that decision was made casually or abruptly. In other words, when I took the exam in January, the Board had to have known that changes were coming, but had not been finalized, or at least not announced. They gladly took my money and time, anyway. One last money grab before the next one.

The next money grab? Yes, I was told I would also be enrolled in the new computerized MOCA 2.0 program, and expected to pay $210 a year for it. There would be no “grandfathering in.” I would essentially receive no credit for the exam I took and of course, there was no getting back all the time I put into studying for and taking the exam.

I called the ABA and expressed my extreme displeasure. Others did, too. Eventually, the ABA actually backpedaled a bit and decided I wouldn’t be charged for MOCA 2.0 for ten years since we had just paid the equivalent of ten years worth of the program to take the exam. I would still be required to enroll in the program, and answer quiz questions on a quarterly basis.

 

 

That $2,100 test, by the way, was a 200 question multiple choice exam that took me 100 minutes to complete. That’s $1,260 per hour for those keeping score at home. I traveled five hours roundtrip to a computerized testing station to take it, too, as there were no computers offering the test any closer to my home.

Since my original Board Certification is valid through the end of this year, I have not yet enrolled in MOCA 2.0, but will be required to start in January, 2018 if I want to maintain my Certification.

 

The Problem With Maintenance of Certification

 

Before MOC was born, we physicians were already required to do Continuing Medical Education, subject to peer review, and many of us maintain many other time-limited certifications, such as ACLS, BLS, and PALS.

On the pages of KevinMD, you’ll find recent takes from anesthesiologist Karen Sibert, MD, who wrote The Real Dangers of Maintenance of Certification and What to Do About It. And from family doctor Linda Girgis, MD, If You are Not Opposed to MOC, the Time Is Now.

Pediatrician Meg Edison, MD has stood up to MOC, sharing her story in this post on KevinMD, and a number of other sordid tales at Rebel.MD.

It’s not that we’re not interested in keeping up our knowledge and skills, it’s just that MOC has not been shown to be an effective way to maintain skills or improve patient care. However, it has been shown to be a costly burden in terms of both time and money.

Speaking of money, a handful of physicians and journalists have been following the MOC money trail, and have uncovered some jarring facts and figures.

 

Kurt Eichenwald wrote the following eye-opening series in 2015 that I would strongly encourage you to read, whether you are a physician or one of our patients.

 

Another gentleman who has championed exposing and undoing the MOC debacle is Dr. Westby Fisher, an electrophysiologist and cardiologist who writes frequently on the topic at Dr. Wes. A good place to start getting caught up are his annual recaps, along with the comments underneath.

 

It’s not that we’re not interested in keeping up our knowledge and skills, it’s just that MOC has not been shown to be an effective way to maintain skills or improve patient care.

 

Do I feel slighted? Yes, but I am far from alone. Dozens of doctors have been sharing their MOC stories, and tens of thousands of others feel slighted, too. The number of physicians currently being subjected to unproven costly MOC requirement likely measures in the hundreds of thousands.

I can’t reclaim the time I’ve spent on MOC, but I am encouraged by the pushback, the resolutions from state and national societies, and the bravery of the physicians who are challenging the status quo.

 

 

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36 comments

  • Physicians are pushing back against these MOCs in all specialties. It’s unbelieveable that instead of taking your money once every 10 years with a mega-test, they take it from you once a year! I bet it probably smooths out their budget…

    At least from a finance perspective, you get to earn interest in the stock market by making ten annual payments instead of one lump sum payment upfront…small consolation.

  • I’m not a doctor so obviously not subject to the same MOC as you. However in a similar way I have to maintain certifications. While not something where I’d lose my job if it expired, I’d likely not get a new high paying job in that field if I didn’t renew my certification. Honestly the older I get the more I feel these types of certifications are just a money grab. The recertification tests/classes/membership fees etc. don’t show whether you can do your job. But they certainly shift money from you to them.

  • VagabondMD

    With some trepidation, I paid my last MOC annual fee just yesterday evening ($340). Technically, I have a prized lifetime certificate from 1995, but years ago I caved in to the pressure of not being designated, “board certified, not participating in MOC” or some such tortured description. There were threats of being dropped from insurance panels or being paid at a lower rate, scary stuff when you are trying to make a living, and your family depends on you.

    As I see the light at the end of the tunnel, I see no need for the annual sanctioned mugging that I allow myself to be subject at the beginning of every year.

  • I really enjoy reading about the requirements and, should I say, hassles, people go through in other industries. I have worked in the pharma industry for about 15 years and I’m no stranger to red tape and silly requirements. I think retiring early to avoid the stupid test again is perfectly acceptable. I often dream of retiring on a whim when I’m assigned a ridiculous project with an equally ridiculous timeline. I’ll definitely write a post about that one 😉

  • Did getting this certification increase your wages or allow you to take on more responsibility? I’m struggling to see the advantages of becoming a diplomate; you mentioned at the 7 year mark, it was important to take the test, but just looking for why! 🙂

    Thanks for sharing your story… hope things change in the future for you and your colleagues.

    • I was board certified as soon as possible after residency, and if you don’t jump through all the hoops, you could be labeled by the Board as “not participating in MOC” which could cause problems with credentialing and insurance participation.

      In other words, it’s become more or less required if you want to work and get paid in most traditional doctor jobs. Check out what happened to Dr. Edison when she chose not to participate in the linked article above.

      Best,
      -PoF

  • Dr P

    The same thing happened to one of the partners in my group, PoF. Fortunately, our hospital pays for the MOC fees so he only had wasted time studying for the recertification exam. I’m sure the dissatisfaction would be even worse with lost time and money.
    As a fresh out of residency grad myself, I passed the initial certification exams and then had to enroll in MOC immediately after passing (before I even had received my certificate in the mail)! What’s the utility in doing additional MOC immediately after 4 years of residency and hundreds of hours spent preparing for written and oral boards?

    • It’s so aggravating.

      The fact that many groups and employers will pay for these things make it easier for many docs to shrug their shoulders and comply. It doesn’t sting as much when the $2,100 comes from someone else’s pocket. Ultimately, though, that money comes from somewhere.

      Best,
      -PoF

  • ABA MOCA is clearly a money transfer program….supported by the educational industry. The licensure fees…reappointment fees…all the different”papers” we have to do….amazingly with no increase in pay.

    I enjoy my job and my patients…but despise the bureaucracy.

  • TheGipper

    I encourage all docs to:
    1) Lobby their hospitals and relevant committees to stop requiring board certification to be on staff and…
    2) Then simply stop paying MOC fees

    The madness must end.

  • artemis

    Great post!

    I have lifetime certification in my specialty (pathology), because I was fortunate enough to complete my training just in time to be grandfathered in. But of course there’s growing pressure on the American Board of Pathology to revoke lifetime certification, and as you point out insurance companies are increasingly trying to impose MOC via the back door by refusing payment if the physician isn’t participating in MOC. So I’m worried I’m eventually going to have to make a nasty choice: retire before I’m really financially ready to, or hop on the endless and pointless hamster wheel of MOC. Increasingly I think that if push comes to shove, retiring before I’ve hit my ideal number is the way I’m going to go. I simply don’t have the patience for this nonsense!

    I suppose the silver lining it that this threat has definitely encouraged me to up my savings rate!

    • Jason

      But isn’t that a terrible shame? Good doctors, like yourself, are being forced to retire early because of this ridiculous process. I see it happening everywhere. There needs to be a nationwide uprising that rids the country of the entire exam. We don’t need it. Its our career. We’re already taking all the legal risk of being a doctor. Why do we need some private company taking our money and pimping us for no reason?

  • I can definitely empathize. I’m no doctor, but I’m a member of two professional guilds to the combined tune of ~$700 p.a. If I let the fees lapse, eventually I’ll be expelled from the guilds and would have to complete the much more expensive and test-intensive process to re-join.

    On the plus side, I think starting one’s own guild is a great entrepreneurial idea!

  • Nooooooooooo. Oh damn, that really freakin’ sucks. At least the ABA had the decency not to charge you for ten years to make up for the cost. That is ludicrous. No wonder so many doctors are frustrated and stressed. Good grief.

  • My (still infantile) industry (software) has no certification requirements (spends a moment gloating, decides to stop just short of becoming obnoxious). Though I suppose the whole interview process every time you job hop is one way of making sure you still ‘know all the answers’. At least it is free. I’m sorry you are being subjected to what sounds like the moral equivalent of paying protection money.

  • Jason

    I’ve waited 6 years from the time I completed my IM residency to even bother taking and passing the ABIM. Once I pass later this year (or next year if I’m not successful this year), I’m good for 10 years and by then I’ll be financially independent and will be able to afford to work part time somewhere that doesn’t care about the boards. That’s my plan. 16 or 17 years of being BE/BC and then I’m good to go:) No MOC, I refuse to participate.

    • That’s brilliant, Jason!

      Most job postings I see require you to be Board Certified or eligible (within 5 or 7 years of residency). Waiting to the last minute to obtain initial certification can be a winning strategy, as long as you’re confident in your ability to pass.

      Best,
      -PoF

  • sfds

    My hospital fired a physician for not to get the recertication license in time. At the same time NP/PAs are allowed to work without need to take any test or re-certification. The NP is now doing the job for the physician who got fired. The irony.

  • Wow, that sucks! Man would I be pissed. I’m a CPA. Our continuing educations requirements thankfully don’t require any further testing, just attending training sessions for credit. I would be pissed if I spent a bunch of money and time on CPE courses only to find one t they no longer matter.

  • You are in the majority opinion on this. I’m a bit of a contrarian I guess. Although I acknowledge the fees are high, they are minuscule compared to the incomes we get. Unfortunately medical knowledge rapidly declines from the moment we leave training. Even though I love learning there is nothing like a forced exam to get me studying. Are you really that much worse off? So you learned some things that you may not use on the job tomorrow. Some of it may be helpful. I know I have used information that I learned studying for a recert exam that I didn’t think applied to me. I’m not expecting to change your view or anyone else’s. Just pointing out that I like the structure and forced exams. I know. I’m weird! LOL

    • Agree to disagree, I guess. I subscribe to both the Anesthesia journal, and Anesthesia & Analgesia. I read articles of interest monthly. I read the “throw-away” trade magazines, and get e-mail updates on advancements in my field. I read the APSF monthly, attend conferences twice most years, and participate in the ACE program for additional CME.

      MOCA does nothing for me. I learn all I need to know and then some on my own out of an obligation to myself and my patients.

  • Michael Iverson

    I really think the boards have shown they exist merely to perpetuate themselves. JCAHO anyone?
    I have a lifetime certification, but I also did the 10 year voluntary recertification. It seemed like a good idea at the time and I was curious to see how hard the recert exam was. Turns out it wasn’t that hard.
    My plan had been to do one more voluntary recert. That would get me to 62y/o and retired or nearly so. With MOCA 2.0, it’s just too much money, too much effort, and mostly just too much pain in the ass. I’m done jumping through all the silly hoops. In the immortal words of Roger Murtaugh, “I’m getting too old for this s*!t.”

    • I hear you loud and clear, Michael. We do plenty of self-educating, CME, and have enough hoops to jump through without MOCA 2.0.

      Love the Lethal Weapon quote — I’ve used it in a previous post.

      Best,
      -PoF

      • Michael Iverson

        Aw, crap! I inadvertently plagiarized you! Apologies.
        I read that post when you first released it. I’m trying very hard NOT to retire from competitive running. You don’t have to get faster; just outlive the competition!

  • This is a problem that is perpetuating throughout many of the medical specialties, where the guidelines for recertification keep changing. My specialty has changed its policies several times over the past few years, with each decision involving its doctors paying a certain amount of money each year.

    The AMA also doesn’t have the power to set guidelines for MOC either!

  • Anne

    I wouldn’t mind paying the fees if I found I actually gained something from the process. For my board, we have to pay a yearly fee, pay another fee to take some bogus self assessments (read an article and answer questions that I already knew the answers to, but have to pay to demonstrate this), do a PI project (this can be done for free but they make it a lot simpler if you pay them for it), and pay for the exam every 10 years. It’s ridiculous. I get much more out of surfing pubmed for free than I do out of the board’s expensive, canned MOC materials. I will be FI by the time my first recert comes around, but I like my job so am playing along for now.

  • Jonathan Buckwold

    Join the National Board of Physicians and Surgeons: nbpas.org
    It is an alternative board, founded for precisely the reasons you eloquently expound. Currently, few hospitals recognize NBPAS. If a torrent of physicians stop subsidizing MOCA fat cats, and join the new competitive board, hospitals will be swept along.

    • I may lobby my hospital to accept it. I might also see if my certificate is truly good for ten years by not enrolling in MOCA 2.0. I don’t want to jeopardize my partners, though, if taking a stand would interfere with credentialing or insurance. It’s very frustrating.

      Best,
      -PoF

  • Jack rose

    Can you provide the details of how you convinced them to pay your fees even though you still have to do the MOCA ?s . I spent a half hour on the phone having explained that I just spent all this money passing the test in 2016 and now I have to pay more every year and that I think it is unfair. Further if you complain it goes to the MOCA dept!

    • I did what you did — I called and raised a fuss right after they announced MOCA 2.0. Eventually, I received notice that I wouldn’t be charged the $210 for 10 years. I’ll look for the e-mail and forward to you. I thought the test wasn’t given after I took it in 2015, but I haven’t been paying that much attention.

      Best,
      -PoF

  • S.G.

    Sounds like you might be ripe for some Institute of Justice videos regarding professional certification and regulation. They probably wouldn’t touch doctors with a ten foot pole, but you can donate so they can fight the good fight so that hair braiders don’t have to go through their version of the same thing. It’s extortion and it’s wrong.

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